Endoscopic vs. Surgical Ampullectomy: an Algorithm to Treat Disease of the Ampulla of Vater

Introduction: Proposed management of benign ampullary lesions includes local resection (endoscopic or surgical ampullectomy) and en-bloc resection (pancreaticoduodenectomy). Most agree that en-bloc resection entails a significant morbidity and mortality. The objective of this study was to compare the effectiveness, morbidity, and mortality of endoscopic ampullectomy (EA) and surgical ampullectomy (SA). No study has previously compared EA versus SA for the treatment of benign ampullary lesions.

Methods: Medical records of patients selected for ampullectomy at Duke University Medical Center from 1991-2010 were reviewed. Results: After review, 109 patients were confirmed to have undergone ampullectomy for a suspected benign ampullary lesion. Sixty-eight patients underwent EA, while 41 patients underwent SA. Patients in each group were identical in terms of age, sex, race, and comorbid conditions, except EA had a higher rate of morbid obesity (BMI > 35). EA was found to have a significantly reduced length of stay, lower morbidity and readmission rates, but had similar rates of mortality, margin-positive excisions, and re-interventions (Table 1).

Conclusion: In patients selected for ampullectomy for benign ampullary lesions, EA was found to be equally effective, have a lower morbidity and identical mortality when compared to SA. These findings suggest that patients would likely benefit from an aggressive endoscopic approach prior to consideration for surgery.

Share this:

Related

Recently, on SAGES…

Mastering the Art of Surgery At the 16th World Congress of Endoscopic Surgery and 2018 SAGES Meeting April 11th–14th in Seattle, WA The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) will kick off its 2018 Annual Meeting as part of the 16th World Congress of Endoscopic Surgery. Hosted by SAGES and CAGS (Canadian Association […]

https://survey.az1.qualtrics.com/jfe/form/SV_5pCM9JWvDBphkjj Who Can Enter Open to any surgeon who is either a member of SAGES or an attendee at the 2018 SAGES Annual Meeting AND who completes the 2018 SAGES Video Based Assessment Online Survey at the link above. Drawing Entry Period The drawing period is from survey launch on April 6, 2018 to 11:59pm […]

Join Us! (Because You Deserve to Play as Hard as You Work) Opening Session Welcome Ceremony & Exhibits Welcome Reception Wednesday, April 11, 5:00 PM – 7:30 PM Join us for highlights of the meeting, the upcoming Dr. Jeff Ponsky video preview, a U.S. military color guard and Canadian bagpiper, and a procession to the […]